HomeMy WebLinkAboutPermit Building 1980-10-9
Address
Construction lender
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I II FORtlATI ON
726-3753
Sq. Ftg. I.jain
~q. Ftg. Access.
Sq, Ftg. Other ((Peo $_
rle\~ Add, A 1 ter ReD.
--Fence Demo Change/Use
Other- -
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:2.8'3 -S3'-S-
Phone
Build Single
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Phone
(address)
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no. l
Address
UI:.~J{jH It.All lnameJ
Primary I/rc.k, k ~7S
Structural ~~~
,
Electrical ~~~
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i1echanical
CDIHRft.cTORS (name I
C. t;7$,},~
Genera 1
Plumbino
Electrical
I.techanical
/l0.
t!
(lies. no.)
(exo; res)
(ohone
~Soc
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(e'ni~~ (ohnne nn. I
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Z<;(~5~?C.
(address)
Cc.w. !. (
(1 ics. no.)
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PLUI1BIIlG
ELECTRICAL
MECHANICAL
each
FfF I [HARr,F
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I SERVICES
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fI-lARr,r; rm'_
---+- fu.rnace/burner to
.I l..J7"'lJl:')n BTlI's
I I-Floor furnace
and vent
I I Recessed wa 11 -
SnnCP hp~t~r ~nrl vpnt
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1-+
,
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Residence of
FFF
FFF
fHAQ(:1=
Each single fixture
SO, FT.
Relocated building
(new fix. additional)
I HAVE CAREFUllY EXAI'HNED the completed aprlication for I)ermlt, and do hereby certify that all information hereon is true
and correct, and I further certify that any and all work oerformed shall be done in accordance with the Ordinances of the City
of Springfield and the laws of the State of Ore~lOn pertairiing to the \...ork described herein, and that 110 OCCUPAIKY \.,.i11 be made
of any structure without the permission of the Building Division. I further certify that my registration with the Builder's
Board is in full force and effect as required by ORS 701.055, that if exempt the basis for exemption is noted hereon, and that
only subcontractors and employees who are in comoliance with OP.S 7nl.055 will be used on this nroject.
1!.^;lO(P~:": P";"o) .0&01''''' s -...J.-:',.t..:.., SI,O;iilTVRE ~~ .
FO~ OFFICE USE O;iL Y /'
Sq. Ftg. 11ain
Sq. Ft~. Access
Sq, Ftg. Other /1..,00
S.F. Residence
(1 bath)
Duplex (1 bath)
Additional bath
Hater service
Sewer
Storm Sewer
Zone I'. - :2..,
Fire Zone -.
Flood Plain .. //)
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,
BUILDING PERI'IlT
Charges an':
Surcharges
PLUi1BING PERMIT
Charges and
Surcharges
ELECTRICAL PER/lIT
Charges and
Surcha rges
11ECHAIIl CAL PERMIT
Charges and
Surcharges
New circuits alts.
or extensions
t-t-. Temporary Construction
Change in existing
re<;.i dJ'}'lcr
I multi~a~ilY, corrrn. or
I ; T;1r!u$..n;;l
.__0"' Of --==-:-~
Appliance vent
<;eoarilte
I Stationary evap.
cooler
~ I Vent fan with I "
c::;."L ~i:,\(I~e dl;C~ ~,'-=' G.oQ
I Vent syster.1 apart from I I
'heatina or A.C.
I j'lechanical exhaust
hond and duct
amps.
I Cor'lf.l./! ND. FEEDERS
I Install/alter/relocate
rli<;trih. fpprler<;
Of ~ n." amps.!
Wood stove/heater
,." "'-
,-.:.;.......'<-J
?or-'"J';;.oo
thi s perl'i1it
um/O-j-fo
Type/Canst. '~jl-,.<l
Bedrooms
Units
Occy Load
Oecy Group
x
'. Value
Val ue
Value
~.Q
~ /
x
Stories
,
,
R-:2
x
TOTAL VALUATION ":~."'irt'? .c.;:~
.., I 00 Plan Ck, Comm/!nd
{ \Q. 65%/RldCl Ppr Fpp
---.:2-C:d:-----Pidn Ck. Res
~. 30%/Blda Per Fpe
c;'O Ino Fence
- - -- - - - --'~I-;" -I Demo
: u v
!0.....cC) I Sidewalk
--------~&;-I AlC Paving
~-----.dd,g9-; Curb Cut
r/r:;/
. ~ (;
L\9 ,~() PD
IIO-to-co
Syste~s Development
Charqe (1.5~)
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In ,1 ;.
;..':'Uz..-...<~".:,c:
1.l"1, '/0,
Total Comb. rermit
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I TOTAL
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CO;':BINATlO;i .,PPLlCATlGri/PERi-1iT (CAP)
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PERMIT VALIDATION
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Applicant to furniSh
A. Job ':"ddress
B. legal Descrinion
1. exar.;ule- Tax Lot
1/ OJ <;3
2. eX~~jle- lot 1. 31ack 3. 2nd Addition to
~prlngrield Estates
C. ria:ne. etc. of o...mer and construction lender
O. Energy Sources
I. exa:'::Jle- heat/electrical ceilina/or forced
2. e_(c~~!e_ ......aterneHerJelectr~.:al!or solar
E. SGuare fOct,1ge or 'Ialuation. etc. -
"I. exa~Dle- 1250'sq. foot house. 500 Sq," foot (
2. eXc~Die- if new project. CheCk-new - if add
cheer; acd. etc.
F. Bullding pemit infonr.dtion:
1. exa;;]ole - construct single family house \..,it
at t.ached garage
2. ey.2::::J}e - rer=:cdel ~xi!:t.;!'1'J adr'~:je i!'"!t~ f;>'~'
3. ~,.cl'lllJi2 - convert single fami'-Iy residence
reS~durant (cnange of use)
G. Value of work as defined in Section 303 {a} of
Stru:tJral Soecialty Code
H. OESiGi: ;:::r=.;.; Aim CONTRACTORS
To avoid design or construction delays. Build ~
Division Staff must be able to contact aDprop
persons regarding design information or job ~
corrections, etc.
Abbrev~atea Plu:;;bing, 1"lechanical. & Electrical S,
A. ~xeeDt where blank SOaces occur in the deser
par~ion of :rle t'lech~nical and Electrical $ch
the appjic~nt need fill-in only the i~o. BaxE
to the aDpro~riate item(s) to be installed
8. Full ?:u:::bing, Mechanical. and Electric,]] SI
are available at the Building Division
1. To conserve space on the permit form th ~
have been abbreviated ~
2. If the item(:;) to be installed. are not
the abbreviated schedules you should cc
full schedules
C, BUILDIi;G OIVISION STAFF llILL FILL OUT ALL
CHARGES Oil THE SCHEDULES
D. As noted on the CAP, the label must
electrical contractor for signature
suoervisor. The general contractor
to sign the electrical label.
Applicant to sign and date
Whenever possible, the initial application wi
d wOi'ks(t~E::L oniy. ~':(jere posslbie, Buihiing r 1si
will prepare a type \1ritten copy ilnd return ~.
applicant at the time the actual permit is i
signature.
Fees and CharQes 1-"
Plan cneck fees are due and payable at the t ,fI'te
appllcJ~ion. ~nn no plans will be :rocessed L--
fees are 0,] id. ':'11 other fees dnc cn<.ln;~s Jf"e ch::e LIne
payable wn~n the pe~lt is "issued. -
(
100. Lane County r'1ap Referen.
CITy OF ~PR'NGF'ElD
CIty HolI '
Springfield 0
Department of 'p r~gon
OFFICIAL RUbl,e Works
ECEIPT
". Date / ") - (, (; No. B
""-',c 19X() ,
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'n rom '---- (~, f\, hn ((~t}:S -i.. (, "'-
..62..dress 7 '7-27 . tI '-, I . (..-
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B.eceived Fore U~I ) l....C-j'1~-:-~. =.. -
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Received' 'Z. ~ 'lX 7 ~-- _
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CITY OF SPRINGfiELD
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City Hall
Springfield, Oregan
Department of Publie Works
OFFICIAL RECEIPT
(
'!. FOR OFt'U::: USE C.':LY
cC roNO. B 54843 (
( \'iU- ~" ,
Da'e lJ..."L r 19
( Rec'd FrO!nf(\Q\J ~ \0 t~ )(J0\.~ UD (
Address L\ ~ 5 ~ (\J&~b\ ld ~
PROJECT CO:lDrTIO:IS TO BE S,~TISfIED BEfO?E 0'
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Received For:
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Permit appl icant exempt from registration W'
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Additional Project Information:
PLANS REVIEWED BY:
name
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~ =:nt R"eceived ~\ ,~~ ~fJ
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"UTHOlltlZEO SIGN"TUA:E
~..HTON"'U"N."CC ~"'NH"~ " L"Gi:NE 0.. .'.D'
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